What is Erythrodermic Psoriasis?
Erythrodermic psoriasis is the least common form of psoriasis. It usually develops during the course of chronic psoriasis, however in some cases it may be the initial type of psoriasis even in children (Camisa 74)
Erythrodermic psoriasis is a complication of an existing condition which may occur in 16-24% of cases of psoriasis. It generally appears in people who have unstable type of plaque psoriasis, where the disease is progressively worsening.
Symptoms of Erythrodermic Psoriasis
The symptoms of Erythrodermic Psoriasis include a rash, which is spread over large sections of the body and characterized by intense redness and swelling, exfoliation of dead skin, and pain. Individuals with this type of psoriasis may experience chills, low-grade fever, and a general feeling of discomfort. Erythrodermic psoriasis appears on the skin as a widespread reddening and exfoliation of fine scales, often accompanied by severe itching and pain. The skin is very inflamed which affects its ability to function properly. It does not retain fluid as normal, which results in the patient feeling constantly thirsty and being dehydrated. It also impairs the skin's performance in maintaining body temperature control so the sufferer may lose heat more easily and be more susceptible to hypothermia.
Benign enlargement of lymph nodes known as lipomelanotic reticulosis is common in erythrodermic psoriasis. This is caused by the absorption of impurities and an inflammatory response to the peeling of the skin.
The Cause of Erythrodermic Psoriasis
Erythrodermic psoriasis may occur as a result of complications in the treatment of atopic dermatitis, drug reactions from medications used to treat another condition, lymphoma, contact allergic dermatitis, or pityriasis rubra pilaris. It may occur in association with von Zumbusch pustular psoriasis. Zumbusch psoriasis affects elderly sufferers more seriously than the younger ones, and has the potential to be life-threatening for older people. Although occurring less frequently in children, it will improve more rapidly in them and might be treated without medication. In 50% of erythrodermic psoriasis cases, there is no known cause. When no cause can be found it may be referred to as an idiopathic exfoliative erythroderma.
Erythrodermic psoriasis is usually caused by the sudden withdrawal of systemic corticosteroids or potent topical steroids, psoriasis therapy involving the use of medications such as chloroquin or beta adrenergic receptor blockers, or due to treatment with excessive amounts of tar or dithranol.
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Treatment of Erythrodermic Psoriasis
This is a more serious form of psoriasis which requires expert medical treatment. A patient suffering from erythrodermic psoriasis generally needs to be hospitalized. The temperature and humidity in the room should be controlled according to the patient’s comfort levels.
The topical therapy perscribed for erthrodermic psoriasis includes an oil-based bath followed by application emollients or moisturizers such as jojoba oil. Jojoba oil is a wax ester which is the most similar to the oil naturally produced by the skin. For this reason it is the least likely to cause a reaction. Jojoba oil, moisturizers or emollients including bath oils can be applied to the affected areas of psoriasis skin as frequently as needed to relieve symptoms of itching, scaling and dryness. Emollients should also be used on the unaffected skin to reduce dryness. Emollient therapy helps to restore one of the skin's most important functions, which is to form a barrier to prevent the spread of bacteria and viruses from getting into the body and therefore help to prevent a rash becoming infected.
Topical steroids are never used. Antibiotics may be perscribed for the treatment of secondary infection, and oral steroids may be used to help control and stem the progression of the condition.
The medical staff may also recommend the use of immune suppressing therapy with medications such as methotrexate, cyclosporine, azothioprine or a similar drug. Oral retinoids are effective in some patients.
Additional treatment to address any issues that may arise such as of the cardiac, renal, fluid, electrolyte, and protein replacement therapy may also be required.
